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    AAO 2020 Video Program
    Ocular Pathology/Oncology

    Purpose To demonstrate the role of different diagnostic and surgical tools in the approach to a choroidal tumor. Methods Clinical, surgical and histopathological findings were correlated in an academic video. Results An 83-year-old female patient presented with a progressive amelanotic choroidal lesion and retinal detachment. Imaging studies revealed a hyperreflective dome-shape lesion, with shaggy photoreceptors and subretinal fluid at OCT angiography, with low to moderate internal ultrasound reflectivity, a hyperintense mushroom-shaped mass on T1 and high enhancement on the post-contrast study at orbital magnetic resonance imaging (MRI). Vitrectomy-assisted biopsy and tumor endoresection with 23-gauge vitrector were performed. First histopathological analysis suggested choroidal melanoma, due to the presence of pigmented cells; nonetheless, immunohistochemical markers confirmed a metastasis from breast carcinoma. Conclusions Histopathology has been the gold standard of diagnosis in neoplastic diseases; nevertheless, immunohistochemical analysis has taken an increasingly important role in the diagnosis as a complementary tool.